Method and Apparatus for Trialing and Implanting a Modular Femoral Hip

ABSTRACT

A modular femoral hip implant trialing system. The system generally includes a proximal body, a fastener, and a fastener retention member. The proximal body includes a proximal bore, a tapered distal bore, and a passageway connecting the proximal bore to the distal bore. The proximal bore, the distal bore, and the passageway are aligned along a first axis. The fastener includes a head in the proximal bore and a stem in the distal bore, the fastener is aligned along the first axis. The fastener retention member is positioned in the proximal bore and is operable to retain at least a portion of the fastener within the proximal bore.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is related to U.S. patent application Ser. No. ______(Attorney Docket No. 5490-000797), entitled “METHOD AND APPARATUS FORIMPLANTING A MODULAR FEMORAL HIP;” U.S. patent application Ser. No.______ (Attorney Docket No. 5490-000798), entitled “MODULAR LATERAL HIPAUGMENTS;” U.S. patent application Ser. No. ______ (Attorney Docket No.5490-000799), entitled “GUIDE ASSEMBLY FOR LATERAL IMPLANTS ANDASSOCIATED METHODS;” U.S. patent application Ser. No. ______ (AttorneyDocket No. 5490-000800), entitled “REVISION BROACH WITH SMOOTH LATERALSIDE;” and U.S. patent application Ser. No. ______ (Attorney Docket No.5490-000801), entitled “ASSEMBLY TOOL FOR MODULAR IMPLANTS ANDASSOCIATED METHOD;” each filed concurrently herewith. The disclosures ofeach of the above applications are incorporated herein by reference.

FIELD

The present disclosure relates to methods and apparatus for trialing andimplanting a modular implant, such as a femoral hip.

BACKGROUND

This section provides background information related to the presentdisclosure, which is not necessarily prior art.

Modular femoral implants often include a proximal body portion and adistal stem portion. The distal stem is curved or bowed to approximatethe natural bow of a femur. During trialing, a trial distal stem isinserted in a reamed femoral canal to determine the proper orientationof the trial distal stem relative to the proximal body portion. Thisorientation is recreated in the implant when the distal and proximalportions are attached.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

The present teachings provide for a modular femoral hip implant trialingsystem. The system generally includes a proximal body, a fastener, and afastener retention member. The proximal body includes a proximal bore, atapered distal bore, and a passageway connecting the proximal bore tothe distal bore. The proximal bore, the distal bore, and the passagewayare aligned along a first axis. The fastener includes a head in theproximal bore and a stem in the distal bore, the fastener is alignedalong the first axis. The fastener retention member is positioned in theproximal bore and is operable to retain at least a portion of thefastener within the proximal bore.

The present teachings further provide for a modular femoral hip implanttrialing system. The system generally includes a proximal body, afastener, a washer, and a fastener retention member. The proximal bodydefines a proximal bore, a distal bore, and a passageway connecting theproximal bore to the distal bore. The proximal bore is axially alignedwith the distal bore along a first axis. The fastener has a head in theproximal bore and a stem in the distal bore. The washer is between thehead and a base of the proximal bore. The fastener retention member isin the proximal bore. The retention member and the washer are onopposite sides of the head. The retention member includes an aperturehaving a diameter smaller than a diameter of the head to retain thefastener within the proximal bore.

The present teachings also provide for a modular femoral hip implanttrialing system. The system generally includes a proximal body, afastener, a rotational locking device, and a fastener retention member.The proximal body defines a proximal bore, a distal bore, and apassageway connecting the proximal bore to the distal bore. The proximalbore is axially aligned with the distal bore along a first axis. Thefastener has a head in the proximal bore and a stem in the distal bore.The rotational locking device is mounted in the distal bore andsurrounds the stem. The rotational locking device includes an innerdiameter that is larger than an outer diameter of the stem. The fastenerretention member is in the proximal bore between the passageway and thehead and is operable to retain the fastener within the proximal bore.

The present teachings further provide for a modular femoral hip implanttrialing system. The system generally includes a proximal alignment jigportion, a distal alignment jig portion, and a support rod. The proximalalignment jig portion includes a support device that is operable tosupport a proximal body having a distal stem mounted thereto. The distalalignment jig portion includes an alignment guide that is operable foruse in identifying a first orientation of the distal stem relative tothe proximal body. The alignment guide is axially aligned with thesupport device. The support rod connects the proximal alignment jigportion to the distal alignment jig portion.

The present teachings also provide a modular femoral hip implanttrialing method that includes the following: mounting a trial distalstem to a proximal trialing device by mating a first tapered surface ofthe trial distal stem with a second tapered surface of the proximaltrialing device and by mating a fastening device of the proximaltrialing device with a receptacle of the trial distal stem so as topermit rotation of the proximal trialing device with respect to thetrial distal stem; inserting the trial distal stem in an intramedullarycanal of a femur for trialing to determine the appropriate orientationof the proximal trialing device relative to the trial distal stem;locking the proximal trialing device to the trial distal stem byrotating the fastening device to drive the fastening device within thereceptacle and to further mate the first tapered surface with the secondtapered surface to prevent rotation therebetween after trialing;mounting the proximal trialing device to a proximal portion of analignment jig; identifying and recording a position of the trial distalstem relative to the proximal trialing device with an alignment guide ata distal portion of the alignment jig; removing the proximal trialingdevice with the trial distal stem mounted thereto from engagement withthe alignment jig; mounting a proximal body implant to the proximalportion of the alignment jig; mounting a distal stem implant to theproximal body implant such that a tip of the distal stem implantapproximates the position of the trial distal stem recorded relative tothe alignment guide to provide the distal stem implant and the proximalbody implant with a relative orientation that is similar to theorientation of the proximal trialing device relative to the trial distalstem during trialing; and implanting the distal stem implant with theproximal body implant mounted thereto in the intramedullary canal of thefemur.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1 is a perspective view of a trial proximal component according tothe present teachings;

FIG. 2 is a side view of the trial proximal component of FIG. 1;

FIG. 3 is an exploded perspective view of the trial proximal componentof FIG. 1;

FIG. 4 is a cross-sectional view of the trial proximal component of FIG.1;

FIG. 5 is perspective view of a trial distal stem according to thepresent teachings;

FIG. 6 is a side view of the trial distal stem of FIG. 5;

FIG. 7 is a perspective view of an alignment jig assembly according tothe present teachings;

FIG. 8 is a side cross-sectional view of the alignment jig assembly ofFIG. 7 in a retracted position;

FIG. 9 is a side cross-sectional view of the alignment jig assembly ofFIG. 7 in an expanded position;

FIG. 10 is a side cross-sectional view of the trial proximal componentloosely mounted to the trial distal stem to permit rotational movementtherebetween for trialing, the trial distal stem is seated in a femur;

FIG. 11 is a side cross-sectional view of the trial proximal componentloosely mounted to the trial distal stem to permit rotational movementtherebetween for trialing;

FIG. 12 is a side cross-sectional view of the trial proximal componentmounted to the trial distal stem, a tool is illustrated in cooperationwith a fastening device of the trial proximal component to tighten thefastening device and restrict rotation between the trial proximalcomponent and the trial distal stem;

FIG. 13 is a perspective view of the trial proximal component and thetrial distal stem connected together and mounted to the alignment jigassembly to identify the orientation of the trial distal stem relativeto the trial proximal component;

FIG. 14 is a cross-sectional view taken along line 14-14 of FIG. 13;

FIG. 15 is a perspective view of a distal stem implant mounted to aproximal body implant mounted in the alignment jig assembly to set theorientation of the distal stem implant relative to the proximal bodyimplant;

FIG. 16 is a cross-sectional view taken along line 16-16 of FIG. 15;

FIG. 17 is a side cross-sectional view of the distal stem implant andthe proximal body implant implanted in the femur;

FIG. 18 is a side cross-sectional view of the trial proximal componentmounted to the distal stem implant inserted within the femur;

FIG. 19 is a side cross-sectional view of an additional embodiment of atrial proximal component according to the present teachings;

FIG. 20 is an exploded perspective view of a locking rod, a proximallocking wedge, and a distal wedge of the trial proximal component ofFIG. 19, as well as a proximal portion of an additional embodiment of atrial distal stem according to the present teachings;

FIG. 21 is a perspective view of a broach according to the presentteachings;

FIG. 22 is a cross-sectional view of the broach of FIG. 21;

FIG. 23 is an exploded view of the broach of FIG. 21;

FIG. 24 is a perspective view of an additional alignment jig assemblyaccording to the present teachings; and

FIG. 25 is a close-up perspective view of a distal platform of thealignment jig assembly of FIG. 24.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings.

With initial reference to FIGS. 1-4, a trial proximal body 10 for amodular femoral implant according to the present teachings isillustrated at reference numeral 10. The trial proximal body 10generally includes a neck 11 having a head engagement trunnion 12 and aproximal surface 14. The trial proximal body 10 defines a proximal bore16 and a distal bore 18 that axially extend through the proximal body 10along axis A.

The proximal surface 14 includes a keyed or anti-rotation lockingportion 20. As illustrated, the locking portion 20 defines a recesswithin the proximal surface 14. The locking portion 20 can be of anysize, shape, or configuration to cooperate with an alignment jig, whichis described herein, to prevent the trial proximal body 10 from rotatingwhen it is secured to the alignment jig.

The proximal bore 16 extends from the proximal surface 14 and into thetrial proximal body 10. Mounted within the proximal bore 16 are aninsert slide 22, a fastener 24, and a washer 26. The proximal bore 16 isconnected to the distal bore 18 by an axial passageway 28. The proximalbore 16 is longitudinally and concentrically aligned with the distalbore 18 along the axis A.

The fastener 24 may be any suitable fastener, such as a bolt asillustrated. The fastener 24 includes a head 30 and a threaded stem 32.The fastener 24 is positioned such that the head 30 is seated within theproximal bore 16 and the threaded stem 32 extends through the passageway28 and into the distal bore 18.

The washer 26 is seated between the head 30 and a bottom surface 34 ofthe proximal bore 16. The washer 26 can be any suitable washer or deviceto prevent the head 30 from contacting the bottom surface 34 and promotea rotational friction lock when tightening the fastener 24, such as aspring-type Belleville washer.

The slide 22 includes a body 36 that defines an aperture 38. Theaperture 38 has a diameter of any suitable size that is smaller thanboth a diameter of the proximal bore 16 and of the head 30. The slide 22further includes flexible tabs 37 that extend from opposite sides of thebody 36. The slide 22 is removably mounted within a slot or transversebore 40 extending through the proximal bore 16 through interactionbetween the flexible tabs 37 and openings 39 defined by side portions 41of the trial proximal body 10. As illustrated in FIG. 4, the slot 40extends along an axis B that is transverse to the axis A. The head 30 ofthe fastener 24 is positioned within the proximal bore 16 between theslide 22 and the bottom surface 34. Thus, the slide 22 prevents thefastener 24 from exiting the proximal bore 16 and retains the threadedstem 32 within the passageway 28 and the distal bore 18. A plurality ofslides 22 having apertures 38 of various different sizes can be providedto retain fasteners 24 of different sizes. In place of the slide 22, aninternal retaining ring can be located within a groove in an interiorsurface of the proximal bore 16 to retain the fastener 24 in theproximal bore 16. In embodiments that include the internal retainingring, the distal bore 18 need not be included.

The proximal bore 16 further includes a threaded portion 42 proximate tothe proximal surface 14. The threaded portion 42 can be used to mountthe trial proximal body 10 to an alignment jig as described herein.

The distal bore 18 is tapered toward the passageway 28, such that it ismost narrow at the passageway 28, to provide a locking taper surface. Asdiscussed herein, the distal bore 18 is of any suitable size and shapeto receive a trial distal stem and/or a distal stem implant. The distalbore 18 can be tapered along any suitable portion of its length and thedegree of taper can vary such that the distal bore 18 tapers to agreater extent proximate to the passageway 28 than distal thereto asillustrated.

The trial proximal body 10 can be provided in a variety of differentsizes and shapes corresponding to bone(s) to be repaired. Multiple trialproximal bodies 10 of different sizes and shapes can be providedtogether in a kit. For example, the multiple trial proximal bodies 10can have necks 11 and distal bores 18 of various different widths andlengths.

With additional reference to FIGS. 5-6, a trial distal stem according tothe present teachings is illustrated at reference numeral 50. The trialdistal stem 50 generally includes a first end 52 having a connectionregion 54 and a second end 56 having a distal tip 58. The first end 52is opposite to the second end 56. The distal tip 58 can define a notch59. The portions of the distal tip 58 defining the notch 59 are flexibleto relieve pressure at the implant site.

The connection region 54 includes a receptacle 60 that extends withinthe first end 52. The receptacle 60 is sized and shaped to receive thefastener 24 of the trial proximal body 10. The receptacle 60 includesthreads 62 that can cooperate with the threaded stem 32 to secure thefastener 24 within the receptacle 60.

The connection region 54 of the trial distal stem 50 further includes atapered outer surface 64 at the first end 52. The tapered outer surface64 extends from the first end 52 to a suitable distance to facilitatereception of the connection region 54 within the distal bore 18 of thetrial proximal body 10 and the formation of a taper lock with the distalbore 18. An annular collar 66 extending from an outer diameter of thetrial distal stem 50 is provided at a distal end of the connectionregion 54.

The trial distal stem 50 is curved or bowed from about the collar 66 tothe second end 56 to approximate the natural shape of a femur. The trialdistal stem 50 can be provided in a variety of different sizes, shapes,and degrees of curvature corresponding to the femur to be repaired.Multiple trial distal stems 50 of different sizes, shapes, and degreesof curvature can be provided together in a kit.

With additional reference to FIGS. 7-9, an alignment jig assemblyaccording to the present teachings is illustrated at reference numeral76. The alignment jig assembly 76 includes a proximal alignment jigportion 78 and a distal alignment jig portion 80.

The proximal alignment jig portion 78 includes an elongated proximalsupport 82 having a pedestal 84 at a first end 85 and a locking knob 86at a second end 87 that is opposite to the first end 85. The lockingknob 86 includes an engagement shaft 88 having threads 90 that areconfigured to engage the threaded portion 42 of the trial proximal body10. The locking knob 86 is seated within a bore 92 that extends throughthe proximal support 82 and has a longitudinal axis C that is transverseto a longitudinal axis D of the proximal support 82, as illustrated inFIGS. 8 and 9. The bore 92 receives a circular spring or washer 94, suchas a split ring washer, in an annular recess 75 of the bore 92. Thecircular spring or washer 94 engages a depression 96 of the locking knob86 to secure the locking knob 86 within the bore 92 while permittingrotational movement of the locking knob 86 within the bore 92.Protruding from the proximal support 82 proximate to where theengagement shaft 88 extends from the bore 92 is an engagement member 98that is sized and shaped to engage the locking portion 20 of the trialproximal body 10 to prevent rotation of the trial proximal body 10 whenit is mounted to the proximal alignment jig portion 78. In this regard,the engagement member 98 nests within the locking portion 20 to restrictrotation of the trial proximal body 10 relative to the proximalalignment jig portion 78.

A proximal support rod 100 extends from the proximal support 82 betweenthe pedestal 84 and the locking knob 86. The proximal support rod 100extends along a longitudinal axis E that is perpendicular to alongitudinal axis D of the proximal support 82, as illustrated in FIGS.8 and 9. The proximal support rod 100 connects the proximal alignmentjig portion 78 to the distal alignment jig portion 80, as furtherdiscussed herein.

The distal alignment jig portion 80 includes an elongated distal support102 having a pedestal 104 at a first end 105 and an alignment tab 106 ata second end 107 that is opposite to the first end 105. The alignmenttab 106 includes a center portion 109 and a tip portion 111 extendingtherefrom. The alignment tab 106 is rotationally mounted to the distalsupport 102 at the center portion 109, which is generally verticallyaligned with the locking knob 86 of the proximal alignment jig portion78 along the axis C.

A distal support rod 108 extends from the distal support 102 between thepedestal 104 and an alignment tab 106. The distal support rod 108extends along the longitudinal axis E, which is perpendicular to alongitudinal axis F of the distal support 102. The distal support rod108 defines a central cavity 110 sized to slidably and coaxially receivethe proximal support rod 100 to restrict rotational movement therebetween. The distal support rod 108 defines windows 113 that permitaccess to an interior of the distal support rod 108.

The distal support rod 108 further includes a locking tab 112 thatengages the proximal support rod 100 to lock the proximal and distalsupport rods 100 and 108 together, and consequently the proximal anddistal alignment jig portions 78 and 80 together as well. The lockingtab 112 can engage the proximal support rod 100 at nearly any positionalong its length, thereby permitting the proximal alignment jig portion78 and the distal alignment jig portion 80 to be moved closer together(FIG. 8) or farther apart (FIG. 9) as necessary to accommodate variousdifferent sizes of the trial proximal body 10 and the trial distal stem50.

With additional reference to FIGS. 10-14, an exemplary method of usingthe trial proximal body 10, the trial distal stem 50, and the alignmentjig assembly 76 is illustrated. While the method is described withrespect to the repair of a femur 150, the present teachings can be usedto repair a variety of other suitable bones as well, particularly boneshaving a curved or bowed stem.

With initial reference to FIGS. 10 and 11, the first end 52 of the trialdistal stem 50 is inserted within the distal bore 18 of the trialproximal body 10 and is secured therein by tightening the fastener 24with a suitable tool 114 engaging a bore 31 of the fastener 24 (FIG.11), such that the threaded stem 32 of the fastener 24 partially engagesthe threads 62 of the trial distal stem 50. The fastener 24 is notcompletely tightened in order to permit rotational movement (illustratedin phantom in FIG. 10) between the trial proximal body 10 and the trialdistal stem 50 during trialing.

An intramedullary canal 152 of the femur 150 is prepared, such as byreaming, and the trial distal stem 50 is inserted therein. As the trialdistal stem 50 is inserted it rotates such that the curvature of thetrial distal stem 50 matches the curvature of the intramedullary canal152 and the overall curvature of the femur 150. The trial proximal body10 is then rotated to a desired position determined from trialing, asillustrated in phantom in FIG. 10. With additional reference to FIG. 12,to preserve the orientation of the trial proximal body 10 relative tothe trial distal stem 50, the fastener 24 is further tightened using thetool 114 so that the tapered outer surface 64 of the trial distal stem50 engages the tapered portion of the distal bore 18 proximate to thepassageway 28 to form a mating taper therebetween and prevent furtherrotation of the trial proximal body 10 to the trial distal stem 50.

The trial proximal body 10 and the trial distal stem 50 locked theretoare removed from contact with the femur 150 and connected to thealignment jig assembly 76 to measure the relative positions of each. Asillustrated in FIGS. 13 and 14, the trial proximal body 10 is mounted tothe proximal alignment jig portion 78 through cooperation between thethreads 90 of the engagement shaft 88 and the threaded portion 42 of thetrial proximal body 10. The engagement member 98 of the proximalalignment jig portion 78 cooperates with locking portion 20 of the trialproximal body 10 to prevent rotation therebetween. The distance betweenthe proximal and distal alignment jig portions 78 and 80 is set suchthat the distal tip 58 is level with the alignment tab 106 and thelocking tab 112 is tightened to secure the proximal and distal alignmentjig portions 78 and 80 in relative position to each other. The alignmenttab 106 is rotated such that it contacts the distal tip 58 or is justdistal to the distal tip 58 to mark the relative position of the distaltip 58 and curvature of the trial distal stem 50, which corresponds tothe natural curvature of the femur 150 determined during trialing.

With the alignment jig assembly 76 set, the trial proximal body 10 andthe trial distal stem 50 are removed from the alignment jig assembly 76.For example, the locking tab 112 can be loosened to permit furtherseparation of the proximal and distal alignment jig portions 78 and 80,thereby opening the alignment jig assembly 76. The locking knob 86 isrotated to disengage the threaded portion 42 and permit separation ofthe trial proximal body 10 from the proximal alignment jig portion 78.The trial distal stem 50 can be removed from engagement with the trialproximal body 10 by unscrewing the fastener 24 from engagement with thetrial distal stem 50. As the fastener 24 is unscrewed it contacts theslide 22 to provide a counterforce against the fastener 24 and assistwith the separation of the trial distal stem 50 from the trial proximalbody 10 by disrupting the taper connection between the distal bore 18and the tapered outer surface 64 of the trial distal stem 50. In otherwords, rotation of the fastener 24 biased against the slide 22 pushesthe trial distal stem 50 out from within the distal bore 18 of the trialproximal body 10.

As illustrated in FIGS. 15 and 16, a proximal body implant 176 ismounted to the proximal alignment jig portion 78. The proximal bodyimplant 176 is similar to the trial proximal body 10 in both size andshape. Further, the interior of the proximal body implant 176 does notinclude the fastener 24. The proximal body implant 176 does include aproximal bore 180 having a threaded portion 182 and a distal bore 184having a tapered interior surface 186. A proximal surface 188 includes alocking member 190 that is configured to mate with the engagement member98 of the proximal alignment jig portion 78.

The proximal body implant 176 is mounted to the proximal support 82through cooperation between the threads 90 of the engagement shaft 88and the threaded portion 182 of the proximal bore 180. Cooperationbetween the locking member 190 and engagement member 98 rotationallyaligns the proximal body implant 176 in the same orientation as thetrial proximal body 10 and prevents rotational movement of the proximalbody implant 176.

Numeral 200 references a distal stem implant. The distal stem implant200 is substantially similar to the trial distal stem 50. Features ofthe distal stem implant 200 that are similar to the trial distal stem 50are designated with the same reference numbers, but further include theprime (′) designation. The portion of the distal stem implant 200between the collar 66′ and the second end 56′ has a diameter that isgenerally larger than that of the trial distal stem 50.

With the proximal body implant 176 still mounted to the alignment jigassembly 76, the distal stem implant 200 is rotated such that its secondend 56′ is aligned with the previously set alignment tab 106 to providethe distal stem implant 200 with the same orientation as the trialdistal stem 50. The second end 56′ can directly contact the alignmenttab 106 or extend proximate thereto depending on its length. Theconnection region 54′ is inserted within the distal bore 184 to form ataper lock therein and secure the distal stem implant 200 to theproximal body implant 176 in the same orientation achieved between thetrial proximal body 10 and the trial distal stem 50.

The proximal body implant 176 and the distal stem implant 200 areremoved from the alignment jig assembly 76 and then further securedtogether using any suitable device, such as by tightening a screw 202seated in the proximal bore 180 of the proximal body implant 176 withinthe threads 62′ of the distal stem implant 200 and/or with an impactor.The distal stem implant 200 is implanted and secured in theintramedullary canal 152 (FIG. 17) in any suitable manner. As a resultof the alignment performed using the alignment jig assembly 76, thedistal stem implant 200 and the proximal body implant 176 are implantedin the femur 150 in the same orientation set between the trial proximalbody 10 and the trial distal stem 50 during trialing.

The proximal body implant 176 and the distal stem implant 200 can be ofany suitable size or shape to repair the femur 150. For example, theproximal body implant 176 and the distal stem implant 200 can beselected from a kit having multiple proximal body implants and multipledistal stem implants of various different sizes and shapes.

With additional reference to FIG. 18, an additional method according tothe present teachings is illustrated. As illustrated, the trial proximalbody 10 can be mounted to the distal stem implant 200 with the distalstem implant 200 implanted in the femur 150. The distal stem implant 200is inserted within the intramedullary canal 152 and follows the naturalshape of the intramedullary canal 152. The trial proximal body 10 ismounted thereto through cooperation between the fastener 24 and thethreads 62′ of the receptacle 60′. The connection region 54′ of thedistal stem implant 200 has a smaller tapered outer surface 64′ than thetapered outer surface 64 of the trial distal stem 50. Thus, the firstend 52′ mates with a proximal end 206 of the distal bore 18 to providerotational stability between the distal stem implant 200 and the trialproximal body 10 through friction. The washer 26 biases the fastener 24upward toward the proximal surface 14 to increase the friction betweenthe first end 52′ and the proximal end 206 of the distal bore 18 toincrease the rotational stability. The trial proximal body 10 can beused for trialing and joint reduction. After the desired orientation ofthe trial proximal body 10 has been set, the position of the trialproximal body 10 is recorded in any suitable manner, such as by markingthe position on the femur 150 and/or through visualization, in order torecreate the same orientation with the proximal body implant 176.

With additional reference to FIGS. 19 and 20, a trial proximal body 250having an alternate locking mechanism for fastening the trial distalstem 50 thereto is illustrated. The trial proximal body 250 generallyincludes a head engagement flange 252 extending from a neck 253, aproximal surface 254, a proximal bore 256, and a distal bore 258. Theproximal bore 256 and the distal bore 258 axially extend through thetrial proximal body 250 along an axis G.

The proximal surface 254 includes a locking portion 259 that is similarto the locking portion 20 and can be of any size, shape, orconfiguration to cooperate with the engagement member 98 of thealignment jig assembly 76 to restrict rotational movement.

The proximal bore 256 extends from the proximal surface 254 and into thetrial proximal body 250. The proximal bore 256 includes threads 257operable to mate with threads 90 of the locking knob 86 of the alignmentjig assembly 76. A slot or transverse bore 260 extends through theproximal bore 256 along a longitudinal axis H that is transverse to thelongitudinal axis G of the proximal bore 256. Seated within thetransverse bore 260 is a button 262 having a center aperture 264. Aspring 266 is mounted within the transverse bore 260 and appliespressure to the button 262 along the longitudinal axis of the transversebore 260 to bias the button 262 away from the transverse bore 260.

A locking rod 268 extends between the proximal bore 256 and the distalbore 258. The locking rod 268 generally includes a first end 270, asecond end 272, a neck portion 274, and a shoulder portion 276. Thelocking rod 268 is positioned such that the neck portion 274 is alignedalong the longitudinal axis H of the transverse bore 260. The neckportion 274 is positioned within the center aperture 264 of the button262 such that a surface 277 (FIG. 20) of the button 262 abuts a flange279 of the neck portion 274 to prevent the locking rod 268 from exitingthe proximal bore 256. The spring 266 maintains the connection betweenthe button 262 and the locking rod 268. The shoulder portion 276prevents the locking rod 268 from moving further into the proximal bore256. The second end 272 of the locking rod 268 includes a threadedportion 280.

Mounted within the distal bore 258 is a proximal locking wedge 282 and adistal locking wedge 284. The proximal locking wedge 282 defines a firstcenter bore 286 and the distal locking wedge 284 defines a second centerbore 288. The proximal locking wedge 282 and the distal locking wedge284 are positioned such that the locking rod 268 extends through boththe first center bore 286 and the second center bore 288.

The first center bore 286 has an inner diameter 287 that issubstantially similar to an outer diameter 289 of the locking rod 268,such that there is little or no transverse movement relative to the axisG between the proximal locking wedge 282 and the locking rod 268. Thesecond center bore 288 has an inner diameter 294 that is larger than theouter diameter 289 of the locking rod 268, thereby defining a gap 296between the distal locking wedge 284 and the locking rod 268. The gap296 permits transverse movement relative to the axis G of the distallocking wedge 284 relative to the locking rod 268.

When used in conjunction with the trial proximal body 250, the first end52 of the trial distal stem 50 includes an angled surface 290. Thus, thefirst end 52 of the trial distal stem 50 serves as a locking wedge, asfurther described below.

To connect the trial proximal body 250 to the trial distal stem 50, thesecond end 272 of the locking rod 268 is inserted within the receptacle60 such that the threads 280 of the locking rod 268 cooperate and engagethe threads 62 of the receptacle 60. The locking rod 268 is rotatedusing any suitable driving device, such as the tool 114 in cooperationwith the bore 291, to draw the first end 52 of the trial distal stem 50within the distal bore 258.

To achieve a rotational lock between the trial distal stem 50 and thetrial proximal body 250, the locking rod 268 is rotated to draw theangled surface 290 of the trial distal stem 50 into contact with thedistal locking wedge 284. As the trial distal stem 50 is drawn furtherinto the distal bore 258, the angled surface 290 pushes the distallocking wedge 284 outward against a sidewall 292 of the distal bore 258to create a rotational friction lock between the distal locking wedge284 and the sidewall 292, as well as between the distal locking wedge284 and the trial distal stem 50 to rotationally lock the trial distalstem 50.

The orientation of the trial proximal body 250 and the trial distal stem50 can be noted using the alignment jig assembly 76 in the same mannerdescribed above. In addition to engaging the trial distal stem 50, thetrial proximal body 250 can also be mounted to the distal stem implant200 for use in trialing and joint reduction by providing the distal stemimplant 200 with an angled surface that is similar to the angled surface290 of the trial distal stem 50.

With additional reference to FIGS. 21-23, a broach 300 according to thepresent teachings is illustrated at reference numeral 300. The broach300 includes an interior engagement and locking mechanism that issubstantially similar to the trial proximal body 10. Thus, interiorengagement and locking features of the broach 300 that are similar tothe interior engagement and locking features of the trial proximal body10 are designated using the same reference numbers.

An exterior of the broach 300 includes a plurality of cutting teeth 302.A bore 304 is provided and is operable to receive a broach handle (notshown) to facilitate positioning of the broach 300. A plurality of slots306 are spaced apart along the exterior of the broach 300 and are eachsized to receive a calcar platform 308.

A neck trial assembly 310 can be mounted to the broach 300 for useduring joint trialing. The neck trial assembly 310 has a locking tab 312extending therefrom that is sized to be received in a recess 314 tosecure the neck trial assembly 310 to the broach.

The broach 300 operates in substantially the same manner as the trialproximal body 10 does. Therefore, the above description of the trialproximal body 10 also applies to the broach 300. For example, the broach300 is loosely mounted to the trial distal stem 50 using fastener 24 andthen trialed in the femur 150 to determine the proper orientation of thebroach 300. As the broach 300 is inserted into the femur 150 the cuttingteeth 302 of the broach 300 can be used to prepare the proximal femurand the surrounding areas. Use of the broach 300 for preparing the femur150 and surrounding areas is further described in U.S. patentapplication Ser. No. ______ (Attorney Docket No. 5490-000800), entitled“REVISION BROACH WITH SMOOTH LATERAL SIDE,” which is concurrently filedherewith and is incorporated herein by reference. After the properorientation of the broach 300 with respect to the trial distal stem 50is set, the fastener 24 is tightened to restrict rotation between thebroach 300 and the trial distal stem 50. The broach 300 and the trialdistal stem 50 are then mounted to the alignment jig assembly 76 torecord the orientation of the trial distal stem 50 relative to thebroach 300. This orientation is then recreated with the proximal bodyimplant 176 and the distal stem implant 200 as described above.

With further reference to FIGS. 24 and 25, another alignment jigassembly according to the present teachings is illustrated at referencenumeral 350. The alignment jig assembly 350 generally includes aproximal support portion 352, a distal platform 354 having a measuringgrid 356, and a support base 358. The proximal support portion 352 ismounted proximate to a first end 362 of the support base 358. Theposition of the proximal support portion 352 along the support base 358can be varied by loosening the proximal knob 366 and sliding theproximal support portion 352 along the support base 358 either proximalto or distal to the first end 362, and then tightening the proximal knob366 to secure the proximal support portion 352 into its new position.The distal platform 354 is slidably mounted proximate to a second end364 of the support base 358 that is opposite to the first end 362. Theposition of the distal platform 354 along the support base 358 can bevaried by loosening the distal knob 368 and sliding the distal platform354 along the support base 358 either proximal to or distal to thesecond end 364, and tightening the distal knob 368 to secure the distalportion 354 into its new position.

The trial proximal body 10 and the proximal body implant 176 can bemounted to the proximal support portion 352 in any suitable manner, suchas with a mounting knob 360, which is structurally substantially similarto and operates in a manner substantially similar to the locking knob 86of the alignment jig assembly 76.

The alignment jig assembly 350 can be used to identify or measure theangular orientation of the trial distal stem 50 relative to the trialproximal body 10 and to recreate the same orientation between the distalstem implant 200 and the proximal body implant 176 in substantially thesame manner as described above with respect to the alignment jigassembly 76. When using the alignment jig assembly 350 the position ofthe stems 50 and 200 is measured using the measuring grid 356 ratherthan using the alignment tab 106. Further, the support base 358 includesmarkings that designate a position for the distal platform 354 dependingon the length of the stems 50 and 200 used.

For example and as illustrated in FIG. 25, the measuring grid 356includes a plurality of uniformly spaced markings, such as radial lines370 emanating from a center point 372 and concentric circles 374surrounding the center point 372. The position of the tip 58 withrespect to the grid 356 can be noted by identifying the intersection ofa particular radial line 370 with a particular concentric circle 374that is closest to the tip 58. Also noted are the positions of theproximal support portion 352 and the distal platform 354 on the supportbase 358, such as by using the notations 376 corresponding to lengths ofthe trial distal stem 50. After removing the trial proximal body 10 andthe trial distal stem 50 from the alignment jig assembly 76 by looseningthe mounting knob 360, the proximal body implant 176, with the distalstem implant 200 mounted thereto, can be mounted to the alignment jigassembly 350 through cooperation between the mounting knob 360 and thethreaded portion 42 of the proximal body implant 176. The distal stemimplant 200 can be rotated such that its tip 58′ is at the sameintersection of the radial line 370 and the concentric circle 374 thatthe tip 58 was at, thereby providing the distal stem implant 200 withthe same orientation as the trial distal stem 50.

While the present teachings describe trial and implant components of amodular femoral implant and a corresponding alignment jig assembly, thepresent teachings can also be applied to any other suitable modularimplant where a stem is aligned relative to a body, including shoulderimplants and knee implants, such as a tibial tray implant having anoffset stem.

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the invention. Individual elements or features ofa particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the invention, and all such modificationsare intended to be included within the scope of the invention.

1. A modular femoral hip implant trialing system comprising: a proximalbody defining: a proximal bore; a tapered distal bore; and a passagewayconnecting the proximal bore to the distal bore; the proximal bore, thedistal bore, and the passageway are aligned along a first axis; afastener that includes a head in the proximal bore and a stem in thedistal bore, the fastener is aligned along the first axis; and afastener retention member positioned in the proximal bore that isoperable to retain at least a portion of the fastener within theproximal bore.
 2. The system of claim 1, further comprising a springbetween the head of the fastener and a base of the proximal bore;wherein the retention member and the spring are on opposite sides of thehead.
 3. The system of claim 1, wherein the distal bore is tapered at aportion proximate to the passageway; wherein the stem of the fastener isthreaded and the fastener is movable to a first position in which thefastener cooperates with a threaded receptacle of a distal stem toretain the distal stem in the tapered distal bore such that the distalstem is free to rotate within the tapered distal bore during trialing;and wherein the fastener is movable to a second position in which thefastener extends further within the threaded receptacle than in thefirst position to retain the distal stem within the tapered distal boreto form a taper lock between the proximal body and the tapered distalbore.
 4. The system of claim 1, further comprising a locking wedgedefining a center bore having an inner diameter that is greater than anouter diameter of the stem of the fastener, the stem extends through thecenter bore thereby defining a gap between the outer diameter of thestem and the inner diameter of the locking wedge; and wherein thelocking wedge is operable to move both along the first axis andtransverse to the first axis to contact an inner surface of the distalbore.
 5. The system of claim 4, wherein the stem of the fastener isthreaded and the fastener is movable to a first position in which thefastener cooperates with a threaded receptacle of a distal stem toretain the distal stem in the distal bore and permit rotational movementof the distal stem relative to the locking wedge and the distal bore;and wherein the fastener is movable to a second position in which thefastener extends further within the threaded receptacle than in thefirst position to draw the distal stem further into the distal bore andmove the locking wedge laterally with respect to the first axis suchthat the locking wedge contacts a sidewall of the distal bore and anangled proximal portion of the distal stem contacts the locking wedge torotationally lock the distal stem and the locking wedge relative to thedistal bore.
 6. The system of claim 1, wherein the proximal body definesa transverse bore extending into the proximal bore along a second axis;and wherein the fastener retention member extends to within thetransverse bore.
 7. The system of claim 1, further comprising a distalstem with a tapered proximal portion operable to form a taper lock witha tapered portion of the distal bore.
 8. The system of claim 1, furthercomprising an alignment jig operable to align a distal stem relative tothe proximal body.
 9. The system of claim 8, wherein the alignment jigincludes: a proximal alignment jig portion; a distal alignment jigportion; and a support portion that extends between the proximalalignment jig portion and the distal alignment jig portion along a thirdaxis to mount the proximal alignment jig portion to the distal alignmentjig portion; wherein the support portion restricts rotational movementof the proximal alignment jig portion relative to the distal alignmentjig portion; and wherein the support portion permits movement of theproximal alignment jig portion relative to the distal alignment jigportion along the third axis.
 10. The system of claim 9, wherein theproximal alignment jig portion includes a locking device operable tosecure the proximal body thereto and an engagement shaft proximate tothe locking device operable to cooperate with the proximal body andrestrict rotation of the proximal body, the locking device is alignedwith an alignment device of the distal alignment jig portion along afourth axis; and wherein the proximal body defines a slot at a proximalsurface that is operable to cooperate with the engagement shaft torotationally lock the proximal body to the alignment jig.
 11. The systemof claim 10, wherein the alignment device includes a grid on a surfaceof the distal alignment jig portion facing the proximal alignment jigportion, the grid includes a plurality of radial lines emanating from acenter point and a plurality of concentric circles surrounding thecenter point; and wherein the alignment device includes a plurality ofnotations along the support portion corresponding to lengths ofdifferent distal stems.
 12. A modular femoral hip implant trialingsystem comprising: a proximal body defining a proximal bore, a distalbore, and a passageway connecting the proximal bore to the distal bore,the proximal bore is axially aligned with the distal bore along a firstaxis; a fastener having a head in the proximal bore and a stem in thedistal bore; a washer between the head and a base of the proximal bore;and a fastener retention member in the proximal bore, the retentionmember and the washer are on opposite sides of the head, the retentionmember includes an aperture having a diameter smaller than a diameter ofthe head to retain the fastener within the proximal bore.
 13. The systemof claim 12, wherein the washer includes a spring-type Bellevillewasher.
 14. The system of claim 12, wherein the distal bore includes atapered portion proximate to the passageway.
 15. The system of claim 12,wherein the proximal body further defines a slot extending through theproximal bore along a second axis that is transverse to the first axis,the fastener retention member is seated within the slot.
 16. The systemof claim 15, further comprising a trial distal stem having a proximalportion that includes a tapered outer diameter and a receptacleextending within the proximal portion.
 17. The system of claim 16,wherein the fastener cooperates with the receptacle in a first positionto secure the trial distal stem within the distal bore and permitrotation of the proximal body relative to the trial distal stem byspacing the tapered outer diameter of the trial distal stem apart fromthe tapered portion of the distal bore; and wherein the fastenercooperates with the receptacle in a second position to mate the taperedouter diameter of the trial distal stem with the tapered portion of thedistal bore to form a taper lock there between, the fastener extendsfurther within the distal bore in the second position than the firstposition.
 18. The system of claim 12, further comprising an alignmentjig operable to align a distal stem relative to the proximal body. 19.The system of claim 18, wherein the support portion includes a firstportion extending from the proximal alignment jig portion and a secondportion extending from the distal alignment jig portion, the firstportion is telescopingly received by the second portion to permitmovement of the proximal alignment jig portion relative to the distalalignment jig portion along the second axis; and wherein the alignmentjig includes a locking tab to lock the first portion relative to thesecond portion.
 20. A modular femoral hip implant trialing systemcomprising: a proximal body defining a proximal bore, a distal bore, anda passageway connecting the proximal bore to the distal bore, theproximal bore is axially aligned with the distal bore along a firstaxis; a fastener having a head in the proximal bore and a stem in thedistal bore; a rotational locking device mounted in the distal bore andsurrounding the stem including an inner diameter that is larger than anouter diameter of the stem; and a fastener retention member in theproximal bore between the passageway and the head that is operable toretain the fastener within the proximal bore.
 21. The system of claim20, wherein the proximal body further defines a slot extending throughthe proximal bore along a second axis that is transverse to the firstaxis, the fastener retention member is seated within the slot.
 22. Thesystem of claim 20, wherein the fastener retention member includes anaperture with a diameter larger than a diameter of the head to permitpassage of the head there through.
 23. The system of claim 20, whereinthe fastener retention member is biased in a locked position in which aspring mounted within the slot biases an outer surface of the retentionmember in contact with a shoulder of the fastener to prevent the headfrom passing through the aperture and out of the proximal bore.
 24. Thesystem of claim 20, wherein the stem of the fastener is threaded and thefastener is movable to a first position in which the fastener cooperateswith a threaded receptacle of a distal stem having an angled proximalsurface to retain the distal stem in the distal bore and permitrotational movement of the distal stem relative to the rotationallocking device and the distal bore; and wherein the fastener is movableto a second position in which the fastener extends further within thethreaded receptacle than in the first position to draw the distal stemfurther into the distal bore and move the rotational locking devicelaterally with respect to the first axis such that the rotationallocking device contacts a sidewall of the distal bore and the angledproximal surface contacts an angled surface of the rotational lockingdevice to rotationally lock the distal stem and the rotational lockingdevice relative to the distal bore.
 25. The system of claim 20, furthercomprising an alignment jig operable to align a distal stem relative tothe proximal body.
 26. A modular femoral hip implant trialing systemcomprising: a proximal alignment jig portion including a support deviceoperable to support a proximal body having a distal stem mountedthereto; a distal alignment jig portion including an alignment guidethat is operable for use in identifying a first orientation of thedistal stem relative to the proximal body, the alignment guide isaxially aligned with the support device; and a support rod connectingthe proximal alignment jig portion to the distal alignment jig portion.27. The system of claim 26, further comprising a pedestal at a first endof the proximal alignment jig portion and an engagement tab at a secondend that extends from the proximal alignment jig portion and is operableto engage a recess defined by the proximal body to rotationally lock theproximal body to the proximal alignment jig portion.
 28. The system ofclaim 26, wherein a first end of the support rod is connected to theproximal alignment jig portion between a pedestal at a first end of theproximal alignment jig portion and the support device at a second end;wherein a second end of the support rod is connected to the distalalignment jig portion between a pedestal at a first end of the distalalignment jig portion and the alignment guide at a second end; andwherein the first end is slidably movable relative to the second end toincrease and decrease a distance between the first end and the secondend, the first end is operable to be fixed relative to the second endwith a fastener.
 29. The system of claim 26, wherein the alignment guideincludes an alignment tab pivotally mounted to the distal alignment jigportion, a center portion of the alignment tab is axially aligned withthe support device; and wherein the alignment tab is moved to at leastnearly abut the distal stem to record the distal stem's position. 30.The system of claim 26, wherein the alignment guide includes analignment grid having a plurality of radial lines emanating from acenter point and a plurality of concentric circles surrounding thecenter point, and wherein the alignment jig includes a plurality ofnotations along the support portion for recording distal stem length.31. The system of claim 26, wherein each of the proximal alignment jigportion and the distal alignment jig portion are slidably movable alongthe support rod and locked to the support rod with a fastener.
 32. Amodular femoral hip implant trialing method comprising: mounting a trialdistal stem to a proximal trialing device by mating a first taperedsurface of the trial distal stem with a second tapered surface of theproximal trialing device and by mating a fastening device of theproximal trialing device with a receptacle of the trial distal stem soas to permit rotation of the proximal trialing device with respect tothe trial distal stem; inserting the trial distal stem in anintramedullary canal of a femur for trialing to determine theappropriate orientation of the proximal trialing device relative to thetrial distal stem; locking the proximal trialing device to the trialdistal stem by rotating the fastening device to drive the fasteningdevice within the receptacle and to further mate the first taperedsurface with the second tapered surface to prevent rotation therebetweenafter trialing; mounting the proximal trialing device to a proximalportion of an alignment jig; identifying and recording a position of thetrial distal stem relative to the proximal trialing device with analignment guide at a distal portion of the alignment jig; removing theproximal trialing device with the trial distal stem mounted thereto fromengagement with the alignment jig; mounting a proximal body implant tothe proximal portion of the alignment jig; mounting a distal stemimplant to the proximal body implant such that a tip of the distal stemimplant approximates the position of the trial distal stem recordedrelative to the alignment guide to provide the distal stem implant andthe proximal body implant with a relative orientation that is similar tothe orientation of the proximal trialing device relative to the distalstem implant during trialing; and implanting the distal stem implantwith the proximal body implant mounted thereto in the intramedullarycanal of the femur.
 33. The method of claim 32, further comprisingidentifying the position of the trial distal stem relative to theproximal trialing device by setting an alignment tab of the alignmentguide that is rotationally mounted to a distal portion of the alignmentjig to approximate a position of the trial distal stem.
 34. The methodof claim 32, further comprising identifying the position of the trialdistal stem relative to the proximal trialing device by recording aposition of the trial distal stem with an alignment grid of thealignment guide having a plurality of intersecting lines emanating froma center point and concentric circles.
 35. The method of claim 32,further comprising using the proximal trialing device to broach theimplant site.